腹腔镜胆总管探查术的临床应用 作者：程建荣.docVIP

腹腔镜胆总管探查术的临床应用 程建荣 张宝宽 王杰 (西乡县人民医院，陕西 汉中，723500) [摘要] 目的：探讨腹腔镜胆总管探查取石术（1aparoscopic common bile duct exploration，LCBDE）的临床效果。方法：回顾分析2008年1月至2011年2月我院为30例患者行 LCBDE的临床资料。术中联合应用胆道镜、腹腔镜胆道取石钳、可弯取物钳取石。结果：27例顺利完成LCBDE，手术时间60-150min，平均90min,中转开腹3例，无手术并发症发生。住院6-10d，平均7.5d。25例随访3-24个月，无黄疸、胆道结石残留或复发。结论：腹腔镜下胆囊切除、胆总管切开取石术具有微创、安全的优点，在严格把握手术指征的前提下，是值得推广的临床治疗胆总管结石的手术方式。 [关键词] 胆总管结石；腹腔镜检查；胆道镜检查；治疗结果 [Abstract] Objective: To discuss the clinical effect of laparoscopic common bile duct exploration (LCBDE)。Methods: The clinical data of 30 patients undergoing LCBDE form January 2008 to February 2011 were collected and analyzed retrospectively. The calculi were taken out with choledochoscopy, laparoscopic bile duct lithotomy forceps and flexible object-cathching forceps during operation . Results：The LCBDE was successfully completed in 27 cases and three was converted to open surgery, and no complications were observed. The operating time ranged form 60 to 150 min(mean 90min). The postoperative hospitalizahion was 6-10d (mean7.5d).follow-up observations lasted for 3 to 24 moths in 25 cases and no jaundice, residual stones in the common bile duct or recurrence were observed 。Conclusions：Laparoscopic common bile duct exploration and calculus removed has the advantage of less invasion and safety. It would be a operative methods to be spreaded if we follow suitable indication. [Key words] choledocholithiasis；Laparoseopy；Choledochoscopy；Treatment outcome 在胆囊结石患者中约有15％-20％同时合并胆总管结石，是胆道外科的常见疾病，以往大都需行开腹胆总管探查术。随着腹腔镜技术的发展及器械的不断改进完善，腹腔镜胆总管探查术(LCBDE)在临床上逐步得到推广应用[1]。2008年1月至2011年2月我院对30例患者施行LCBDE，疗效满意，现将结果报道如下。 1 资料与方法 1.1 临床资料 本组30例中男9例，女21例，24～69岁，平均56.9岁。术前均明确诊断为胆囊结石或合并胆总管结石，胆总管直径1.0～2.0cm。8例有黄疸病史，2例胆源性胰腺炎病史，全部为择期手术。患者均无上腹部手术史。 1．2 诊断方法 所有患者常规B超检查，其中B超检查明确胆囊结石并胆总管结石25例，占83.3%；其余4例，B超检查明确胆总管结石，1例胆总管结石可疑，逐进行MRCP，明确诊断为胆总管结石。 1.3 手术方法 术前留置尿管，常规气管插管全麻，操作孔的选择同腹腔镜胆囊切除术。先行腹腔镜下胆囊切除术，胆囊管及胆囊动脉分别用钛铗夹闭。电钩切开胆总管前壁浆膜，细针穿刺证实，在胆总管欲切开部位纵行切开胆总管1.0—1.5cm，从剑突下Troear置入胆道镜探查胆总管。胆道镜下用取石篮套取或用腹腔镜下胆道